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Why Am I So Tired?

Patients often ask me, “Why am I so tired all the time?” This question, of course, has many possible and complex answers. Caring for our families, working long hours or just doing the many daily tasks of living can make us tired. However, one common medical cause of significant daytime fatigue is obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a condition when people have episodes of apnea that disrupt the normal cycles of sleep. Apnea is when you have an abnormal pause in breathing; in sleep apnea, episodes of apnea that are 10 seconds or longer are significant. The apnea is commonly caused when tissues of the throat relax and block your airway. OSA is more common in obese or overweight people but can certainly affect people with a healthy body weight as well.

The symptoms of OSA are heavy snoring at night, choking or gasping during sleep, frequent nighttime awakening, and waking up with headaches. As a result people with OSA often report feeling unusually tired during the day despite sleeping for an appropriate length of time.

In order to confirm that a person has sleep apnea they need to undergo a sleep study where episodes of apnea can be measured during sleep. A sleep study is considered positive for OSA if a patient has five or more episodes of apnea in one hour accompanied by symptoms of sleep apnea; if there are fifteen or more episodes of apnea in one hour the test is positive regardless. In many cases, sleep studies can now be performed overnight in your own home (without having to sleep at a sleep center) making testing much more convenient for patients.

OSA is often treated by using CPAP (Continuous Positive Airway Pressure) to prevent tissues of the throat from collapsing. Many patients cannot imagine sleeping with a mask on and a machine running, but masks can be fitted for comfort; at times other devices such as a nasal fitting can be used instead of a mask. Additionally, newer machines can be quieter and smaller than many old devices. Sometimes people can use mouth guards to prevent airway collapse. In certain cases some patients may need surgery to remove large tonsils or fix a deviated nasal septum that can block airflow. Losing weight and then maintaining a healthier body weight can even cure OSA in certain cases.

Some patients feel that their OSA symptoms are only mildly bothersome and manageable so why should they go to the trouble of having a sleep study or wearing a CPAP machine? The answer is that OSA is actually harmful to you. Episodes of apnea deprive your body of oxygen making your heart work harder to move what oxygenated blood it has around the body and this can actually cause high blood pressure. Over time, this damages your heart and increases your risk for heart attacks, strokes and chronic heart failure. OSA can also cause heart arrhythmias such as atrial fibrillation that can require medication to manage long term and in some cases be life threatening. OSA can also cause problems with memory and concentration due to chronic sleep deprivation, and increase your chances of depression.

OSA seems like a fairly minor disease that just makes people tired but it actually damages your cardiovascular system and prevents you from being at your mental best. Diagnosis and treatments for OSA are much easier to obtain and use. If you feel you are struggling with these issues talk to your doctor, as a good night’s sleep does wonders to make life more manageable and to keep your body healthier.